Improving Nursing Quality Indicator Outcomes with the use of Nursing Informatics

Purpose:
As the patient length of stay increases during hospitalization, new priorities develop. As new priorities develop, older ones begin to get overlooked. Nursing Informatics provide nursing a continuous mode of communication, information and knowledge to help improve the quality of care.

Significance:
Patient falls and pressure ulcer development in the acute care setting are a challenge that needs continuous improvement. Effective IT measures produce better outcomes.

Strategy and Implementation:
To improve communication among nurses, several measures were implemented to alert the staff of a patient's fall history. Fall risk medications were tagged visually in the patient's electronic medical record (EMR) for nurses to view during administration. In the fall risk assessment tool, several components of the patients profile (ie. patient fall history) were locked to ensure fall risk awareness. During patient admission assessments, fall history was added and linked to all change of shift reports. Additionaly, pressure ulcer risk precautions were also added to the patient's profile. Such precautions were also linked to Nursing and Nursing Assistant change of shift reports. Verbiage for Braden was enhanced to assist in more accurate scoring among nurses. A wound care manual was uploaded into the EMR which was accessible to all staff. In the admission assessment, history of pressure ulcer was added to the skin assessment component to further help identify those at risk.

Evaluation:
Since implementation of the IT changes, inpatient falls have dropped 25%, maintaining an average fall rate of 1.5 falls/1000 patient days. Our facility has been HAPU free for 6 months. Success is measured through monthly incident reports, daily skin assessments, and quarterly prevelance for NDNQI.

Implications for Practice:
Some prevention strategies are obvious and may be used with many patients, however, there are some patients who present more of a challenge and demand creative and innovative solutions. Methods used increased fall prevention and pressure ulcer awareness which dramatically lowered these rates.